SNRIs May Be More Tolerable Than SSRIs for Some Youth With Anxiety, OCD

Youth who are taking antidepressants in the class of serotonin reuptake inhibitors (SSRIs) for anxiety or obsessive compulsive disorder (OCD) are more likely to experience side effects that cause them to discontinue the medication than those taking serotonin-norepinephrine inhibitors (SNRIs), according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

SSRIs also appear to be more commonly associated with “activation syndrome”—a cluster of symptoms including restlessness, anxiety, and agitation.

Both classes of antidepressants are commonly prescribed for young people with anxiety and OCD, although SSRIs have been shown to be more effective. There are few data on specific side effects that may cause children and teens to stop taking these medications; however, this analysis suggests that SNRIs may be an option for youth who experience adverse effects with SSRIs, wrote lead author Jeffrey A. Mills, Ph.D., of the University of Cincinnati School of Business and Jeffrey Shawn, M.D., of Cincinnati Children’s Hospital.

The researchers analyzed data on adverse reactions to SSRIs and SNRIs in 18 studies involving more than 2,600 children and teenagers under the age of 18 treated for anxiety or OCD. The studies compared the two classes of drugs with placebo. The SSRIs that were studied were fluoxetine, fluvoxamine, sertraline, and paroxetine; the SNRIs were venlafaxine, atomoxetine, and duloxetine.

In the analysis looking at combined results for anxiety and OCD, the relative risks associated with sedation, abdominal pain, headache, and activation syndrome were greater for SSRIs than for SNRIs. The association with treatment discontinuation was also greater.

The researchers also noted that neither SSRIs nor SNRIs were more associated with suicide than placebo. This finding is in keeping with other research indicating that suicide among youth taking these medications is related to the underlying condition of depression and/or anxiety, not to medication effects.

For related information, see the Psychiatric News article, “Childhood Anxiety Can Be Treated—The Challenge Is to Recognize It.”

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